Focal Treatment Alternatives in Prostate Cancer

Abstract

Yard. Doc. Dr. Mert Ali Karadag, Kafk as Universitesi Tip Fakultesi, Uroloji Anabilim Dali, Kars, Turkiye, Tel. 532 558 43 24 Email. karadagmert@yahoo.com Gelis Tarihi: 13.03.2014 • Kabul Tarihi: 03.02.2015 ABSTRACT The destiny of prostate cancer patients has been dramatically changed since the introduction of prostate specifi c antigen (PSA) into clinical use in late 1980s. Currently more men are diagnosed with localized, small, less aggressive and non-lethal prostatic carcinoma. Besides radical prostatectomy, cryosurgical ablation of the prostate, brachytherapy and high-intensity focused ultrasound have been accepted as alternative treatment options in clinically localized prostatic carcinoma. In this review, we aimed to evaluate the success and complication rates of alternative focal treatment options as the primary outcome. The secondary outcome of this review was to defi ne the candidate patients eligible for these procedures. We searched the Medline using specifi ed expressions including “focal treatment alternatives of prostatic carcinoma”, “high-intensity focused ultrasound and cryosurgery of prostatic carcinoma” and “radiofrequency ablation of prostatic carcinoma”. A total of 1173 papers related to the focal treatment options were analyzed and only 45 of them related to the subject were included. There wasn’t a controlled trial dealing with the topic. American Urologic Association guidelines have accepted cryosurgical ablation of the prostate as a therapeutic option; however the high-intensity focused ultrasound is still considered as an experimental treatment option, although it has been developed as a minimally invasive procedure with reduced morbidity and potentially with the same therapeutic effi cacy in comparison with the surgical or non surgical options. For patients meeting the variable criteria for regular follow up visits without intervention but experiencing anxiety with the feeling of losing active treatment options, focal therapies may be ideal alternatives. However, focal therapy options should be spared for patients with low to moderate risks. The radiologic and clinical stages should be below T2b and T2a, respectively. In addition, all candidates should be informed that the alternatives are considered as experimental and they may need an alternative treatment option in time. Focal therapy alternatives may be more realistic treatment options in the near future; however, well designed multicenter prospective randomized trials are required to provide evidence based data.